ABSTRACT
Abdominal sepsis is a common clinical condition requiring management in the intensive care unit and may present significant diagnostic and management challenges. The core principles of therapy include appropriate and timely resuscitation, antimicrobial therapy, and source control; each impacting the outcome of critically ill patients with abdominal sepsis. Most intraabdominal infections are due to enteric bacteria. Community acquired secondary peritonitis is typically polymicrobial with facultative and aerobic gram-negative, gram-positive, and anaerobic organisms. Critically ill abdominal sepsis patients with failure of source control present significant diagnostic challenges. Patients with recurrent or persistent peritonitis and with nosocomial infections have an increased prevalence of resistant gram-negative pathogens, Enterococcus spp., methicillin resistant Staphylococcus aureus, and yeast typically requiring three agents to achieve appropriate coverage of pathogens. For critically ill patients, empiric therapy should be directed to include all these pathogens with either single agent or combination therapy.
